Accurate diagnosis of epilepsy is challenging because clinicians rarely observe actual clinical seizures outside the hospital.
addition, psychotic non-epileptic seizures (PNES) can mimic seizures (ES), leading to incorrect diagnosis and inappropriate treatment.
, a key gap in the diagnostic evaluation of seizures is the ability to distinguish between ES and PNES blood tests.
serum oxytocin levels have been proposed as biomarkers to distinguish between ES and PNES, however, a meta-analysis of 15 studies assessed serum oxytocin and other markers such as ACTH, cortisol, neurons Heteroolase, creatinase, glutamate transaminase and brain-source neurotrophic factors indicate that although these serum protein levels may change after ES, they are excluded from clinical practice due to lack of diagnostic sensitivity, specificity and accuracy.
instead, explore alternatives that use patient characteristics and clinical history to create an algorithm that might distinguish between patients with PNES and ES.
growing evidence that neuro-inflammation is highly associated with ES.
ES activates systemic and brain inflammatory pathps, including leukocyte mesokine 1 beta production enhancement, activation of tooll-like subjects, mammalian targets of ripple mycomycin, and fissurer activation protein kinase cascades, attracting activated lymphocytes, activating small glial cells and macrophages, and altering the physiological structure of star-shaped glial cells.
a recent meta-analysis of 149 study articles supported the use of blood-based measurements of inflammatory markers for ES diagnosis.
, in preclinical models, blocking inflammation can reduce or prevent seizures, and new epilepsy therapies are being developed for inflammatory pathways.
, John Gledhill of Spring House in the United States and others speculated that changes in the levels of selected plasma markers for nerve inflammation would help distinguish between ES and PNES.
24 hours after the electro-encephalogram confirmed ES or PNES, they collected daily blood samples from patients assessed by the Epilepsy Monitoring Unit (EMU) and isolated the bleeding slurry.
used ELISA to quantify the levels of 51 candidate plasma proteins, and then used diagnostic algorithms for integration and analysis.
results showed that 51 protein multiple ELISA panels were used to determine plasma concentrations in ES patients, PNES patients, and healthy controls.
combinations of TAL, ICAM-1, MCP-2, and TNF-R1 can reflect a patient's recent seizures.
and the concentrations of RAIL and ICAM-1 in PNES are higher than ES.
MCP-2 and TNF-R1 of ES are higher than PNES.
the diagnostic algorithm, the AAUC was 0.94±0.07, the sensitivity was 82.6% (95% CI: 62.9-93.0), and the specificity was 91.6% (95% CI:74.2-97.7).
addition, the extended diagnostic algorithm enhances diagnostic performance by including previously identified PNES risk factors, with AUC at 0.97±0.05, sensitivity at 91.3% ;(95% CI: 73.2-97.6), and specificity at 95.8% ;(95% CI:79.8-99.3).
importance of this study is the discovery of four plasma proteins that provide a fast, economical and accurate blood diagnostic test to confirm recent ES or PNES.
origins of the original text: Association of Epiptic and Non-epileptic Res and Changes in Lysing Plasma Proteins Linked to Neuroinflammation; John Gledhill, Elizabeth Brand, et al. Neurology Jan 2021, 10.1212/WNL.0000000000011552; DOI: 10.1212/WNL.000000000000011552Freeman Source: MedSci Original Copyright Notice: All noted on this website "Source: Met Medical" or "Source: MedSci Original" text, images and audio and video materials, copyrights are owned by Metz Medical, without authorization, no media, website or individual may reproduce, authorized to reproduce with the words "Source: Mets Medicine".
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